Blood in the urine, whether visible or detected during a urine test, may have a range of possible causes. To determine where the bleeding may be coming from, your doctor will typically assess your symptoms, medical history and other relevant factors before deciding which tests may be appropriate. Diagnosing haematuria may involve urine and blood tests, imaging and, when appropriate, direct examination of the urinary tract.
Key Takeaways
- Haematuria is usually investigated using several methods rather than a single test.
- Your doctor will first ask about your symptoms, health history and factors that may influence the investigation.
- Urine tests can confirm the presence of blood, while blood tests may provide information about kidney function.
- Imaging can help examine the kidneys, ureters and bladder for possible sources of bleeding.
- Cystoscopy may be recommended in some cases to examine the bladder and urethra directly.
- The tests required vary between patients based on their individual circumstances and initial findings.
What Does the Haematuria Diagnostic Process Involve?
Your doctor will typically begin by confirming the presence of blood in the urine (haematuria) and assessing factors that may help identify where the bleeding is coming from.
The diagnostic process may include a medical consultation, urine and blood tests and imaging of the urinary tract. Depending on the findings and your individual risk factors, further investigations may also be recommended.
Because blood in the urine can be associated with the kidneys as well as other parts of the urinary tract, the findings may help determine whether further kidney-focused assessment or evaluation by a urologist is appropriate.
What Happens at Your First Haematuria Consultation?
A haematuria assessment generally starts with a detailed consultation rather than immediately proceeding to scans or invasive tests.
Reviewing What You Have Noticed
Your doctor may ask whether the urine appeared pink, red, brown or tea-coloured and whether you noticed blood throughout urination or only at particular times. You may also be asked about associated symptoms such as discomfort when urinating, urinary frequency, difficulty passing urine, abdominal or side discomfort, fever or blood clots.
Understanding Your Medical History
The doctor will also review factors that may influence the investigation plan, including previous urinary problems, medical conditions, medications, smoking history and previous procedures involving the urinary tract.
This stage helps determine which investigations are appropriate rather than applying exactly the same testing pathway to every patient.
Which Tests May Be Used to Investigate Blood in the Urine?
After the initial assessment, your doctor may recommend tests to confirm haematuria, assess kidney function and examine different parts of the urinary system. The investigations required vary from person to person and not everyone will need every test.
Urine Testing
A urine test is often one of the first investigations performed. Urinalysis can detect blood that may not be visible and provide additional information about substances or cells present in the urine.
Depending on the clinical situation, a urine sample may also be sent for further laboratory analysis. Occasionally, repeat testing is recommended to determine whether haematuria persists.
Blood Tests
Blood investigations may be ordered to assess kidney function and provide information relevant to the overall evaluation. The precise tests required will depend on the patient's history and clinical findings.
Imaging of the Urinary Tract
Imaging allows the doctor to examine parts of the urinary system that cannot be assessed through urine testing alone.
Depending on the individual’s clinical situation, an ultrasound or another form of imaging may be recommended. The purpose is to obtain a clearer view of structures such as the kidneys, ureters and bladder.
The most suitable imaging method depends on clinical factors including the patient's age, symptoms, kidney function and overall risk profile.
Cystoscopy
In some cases, further examination of the lower urinary tract may be recommended. Cystoscopy allows a urologist to examine the inside of the urethra and bladder using a thin instrument called a cystoscope.
This examination can provide information about the bladder and urethra that may not always be obtained through urine tests or imaging. Whether cystoscopy is recommended depends on your symptoms, medical history, risk factors and findings from the initial assessment.
During the procedure, the cystoscope is carefully passed through the urethra so the urinary passage and bladder lining can be inspected directly. Your doctor will explain how the procedure is performed, whether numbing medication or anaesthesia may be used and what to expect afterwards.
Get Haematuria Assessed at The Kidney Health Care Clinic
When blood in the urine persists or remains unexplained, further assessment may help get to the bottom of where the bleeding is coming from and what may be causing it.
At The Kidney Health Care Clinic, patients with haematuria and other kidney-related concerns are assessed under the care of Dr Alvin Ng, senior consultant nephrologist. Your individual needs, concerns and preferences are considered when planning your care, with Dr Ng taking the time to explain your condition, investigation results and recommended next steps.
If you have persistent or unexplained blood in your urine, schedule an appointment with us for further assessment.
Frequently Asked Questions (FAQs) About Haematuria Diagnosis
A photograph may sometimes help demonstrate the colour or appearance you observed, particularly if the haematuria is no longer visible by the time of your consultation. However, photographs cannot replace medical assessment or laboratory testing.
Visible haematuria may occur intermittently rather than every time you urinate. If the urine returns to its normal colour, it is still useful to tell your doctor when the bleeding occurred, how long it lasted and whether it has happened previously.
Bring a current medication list and any previous urine test results, blood test results, scans or specialist reports that may be relevant. A short record of when you noticed the bleeding and any accompanying urinary symptoms can also make the consultation more informative.
Meet Our Doctor
Dr Alvin Ng is a senior consultant nephrologist with over two decades of experience in kidney care. Prior to setting up his own practice, Dr Ng was the Director of Peritoneal Dialysis at Changi General Hospital and executive committee member of the Singapore Society of Nephrology. He has held teaching appointments for medical students and residents and is also a recipient of various service awards, a testament to the quality of care he provides.
